How common is it? Right now, more than 1 out of 3 Americans has pre-diabetes. The Centers for Disease Control and Prevention (CDC) estimates that by 2050, one out of every three of us will have full-blown diabetes. In the last 10 years, the number of people in the US with diabetes has more than doubled. This is mainly due to the epidemic of overweight and obesity.

Why worry about it? Unless people with pre-diabetes take steps to control their blood glucose, 15-30% will progress on to full-blown diabetes within 5 years. And diabetes has very bad consequences, if it’s not well-controlled. It is the number one cause in the US of adult-onset blindness, kidney failure, and surgical amputations; it also commonly leads to erectile dysfunction in men, and increases risk of heart attacks and strokes.

Who should be tested? Only one in ten people with pre-diabetes are even aware they have it. Everyone age 45 or above who is overweight or obese needs to be tested. In addition, overweight/ obese adults under age 45 should be tested if they also have one or more of these risk factors:

Habitual physical inactivity

Family history of diabetes

Have previously been diagnosed with “impaired fasting glucose”

Members of certain ethnic groups: Asian-American, African-American, Hispanic/Latino, or Native American

Have elevated blood pressure or hypertension

Women who have had “gestational diabetes” or gave birth to child weighing over 9 pounds

Have HDL (good type) cholesterol of 35 or below, OR have triglyceride level of 250 or above

Have a history of vascular disease (includes heart attacks, and peripheral vascular disease)

Women with polycystic ovary disease

How can it be treated (or better yet, prevented)? Many doctors just want to prescribe a pill, but what works better, lifestyle changes or drugs? Here are two videotapes by Dr. Michael Greger, of NutritionFacts.org, which address this question, plus short summaries. [Click link to watch video].

In this video, Dr. Greger discusses two landmark studies, both published in the New England Journal of Medicine. Here are summaries:

Large study of people with pre-diabetes, comparing metformin vs. diet and exercise vs. placebo as to how many developed full-blown diabetes. Metformin is the most widely used diabetes drug; it does work, but has side effects of diarrhea, nausea, and weakness or fatigue. Metformin worked better than placebo: the number of people developing diabetes within the four-year study period was reduced by 31 percent. But lifestyle intervention using diet and exercise alone worked even better: 58 percent reduction in diabetes incidence, and with very few side-effects.

Study of 500 people with prediabetes comparing lifestyle intervention vs. control group. The dietary interventions were to eat more fiber, meaning whole plant foods, and cut down on saturated fat — mostly dairy, dessert, chicken, and pork. They found that among those people who made all of the recommended changes, NO one developed diabetes. This means a 100% drop in risk. So, Type 2 diabetes can be prevented by changes in lifestyle even in high-risk prediabetic subjects.

Summary: all the major medical societies agree that for people with prediabetes, lifestyle modification is now considered the cornerstone of diabetes prevention. Diet-wise, that means individuals with prediabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. The latest dietary guidelines aim to shift consumption towards more unrefined plant-based foods, including whole grains.

Dr. Greger presents a study demonstrating that whole grain consumption can protect against developing prediabetes. Another study showed that giving prediabetics two tablespoons of ground flax a day decreased insulin resistance, which is the hallmark of diabetes.

Dr. G. then wonders why don’t more doctors follow the recommendation to use lifestyle changes as the preferred treatment for prediabetes, given that it’s so safe and highly effective. Only about 1 in 3 patients report ever being told about diet or exercise.

Doctors receive almost NO training in nutrition. A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education has not changed since 1910. Doctors generally do not like to talk about subjects they don’t understand. Another problem pointed out is that doctors are poorly reimbursed for counseling.

So, you should not rely only on your doctor for help in preventing, or treating prediabetes. The good news is that whole food, plant-based nutrition does a great job in treating prediabetes, without needing any medication at all.

Visit our Contact Page for an appointment or for more information, if you have prediabetes, or if you are concerned you MIGHT have it.